RCM Quality Assurance & Compliance Specialist

This role audits revenue-cycle work, identifies operational and compliance risk, and helps teams prevent errors before they affect patients, clients, payers, or collections.

Responsibilities

• Audit claims, account notes, coding-related workflows, eligibility, authorization, payment posting, A/R, denials, and client reports against approved standards.

• Track error rates, root causes, corrective actions, and repeat findings; maintain defensible audit documentation.

• Review adherence to payer, client, HIPAA, privacy, security, minimum-necessary, ethical-billing, and company requirements.

• Escalate suspected overbilling, underbilling, false documentation, improper access, conflicts, retaliation, privacy incidents, or other misconduct immediately.

• Support training, SOP improvements, calibration, quality dashboards, and corrective-action follow-up.

• Preserve evidence and cooperate with lawful internal, client, payer, and regulatory reviews.

Qualifications

• Two or more years of healthcare RCM, billing, coding, denial, audit, compliance, or quality experience preferred.

• Strong knowledge of claims, EOB/ERA review, payer requirements, documentation standards, and common revenue-cycle risks.

• Excellent analytical judgment, attention to detail, written communication, and discretion.

• CPC, CPB, CRCR, CHC, auditing, or related credential preferred but not required unless stated in an offer.

Independence and Non-Retaliation

The specialist must report findings objectively and must not alter, suppress, backdate, or conceal records. Good-faith reporting and participation in reviews are protected from retaliation. The role has no authority to provide legal advice or bind AdvantixxRCM or a client.

Performance

Success includes audit accuracy, timely escalation, corrective-action closure, repeat-error reduction, documentation quality, training effectiveness, and protection of patient, client, payer, and company information.

Employment Notice

This is a full-time U.S. employee opportunity with remote eligibility. Final classification, schedule, location, compensation, and benefits will be stated in the written offer. Employment is contingent on applicable identity, work-authorization, background, credential, and reference verification and required agreements. AdvantixxRCM is an equal opportunity employer.

About AdvantixxRCM

AdvantixxRCM is a healthcare revenue-cycle management company supporting medical practices and healthcare organizations with accurate, compliant, and service-focused billing operations. Our culture values ethical billing, patient-conscious service, accuracy, ownership, respectful collaboration, continuous improvement, privacy, security, and speaking up.

Team members protect confidential patient and client information, use only authorized systems, and follow company, client, payer, HIPAA, and applicable legal requirements. AdvantixxRCM is an equal opportunity employer.